icarus
Forum Senior
Topics: 27
Posts: 173
|
hi friend , lets try and answer ur questions one by one
1- Yes ,examine all pulses (radial ,and dorsum of foot) bilaterally ,also examine the edema ... it wont take 20 second for all of these ... just say ... i need to feel ur pusles up and down ... i will see if theres any fluid retention.
2- Always always always Listen to the heart and lungs ...and always write (no matter what case do u have... unless its a telephone case) :
Patient is in no acute distress. ( if thats the case )
Vs: WNL
Chest : No tenderness, clear breath sounds bilaterally ,ø wheezing/crackles/rhonchi
Heart: RRR;Normal S1/S2; ø Murmurs/Gallops/Rubs ; PMI not displaced.
Perform a brief neuro when neuro is needed ,and by brief i mean dont dwell much on manoeuvres ... for example dont do brudzinski or kernig unless u have ( fever ,stiff neck , vomiting) ... and do MMSE only in cases of : Stroke ,Seizures ,head trauma ,Dementia ,Forgetfulness,Confusion,LOC,Depression)
Brief Neuro is the key , Cranial ,Cerebellum ,Motor ,Sensory ,reflexes (bi-tri-knee-babinski)
for cerebellum : tell patient to flip hands quickly ... and tell him to do nose to finger manoeuver .... thats more than enough in my opinion
equivalent of palpate : i will touch and feel your ____ now sir.
Tell the patient the DDx ( Pneumonia ,cholecystitis) and then explain it in vague terms like infection of lung ,infection of gallbladder which is the organ situated here (and point to it)
Fundus exam : ALWAYS IN HTN AND DM CASES ... ALWAYS ... also in cases of elevated pressure in the brain ,vomiting,headaches ,suspected tumor or hemorrhage.
When u are asking hands ask this : so what do u do for a living mr_____ .... Oh really ???? my father/mom/exwife lol used to do that ... i know how stressful this job might be Doing bla bla bla all the time ..... do u have stress in ur life mr ??
So u have asked abt occupation + stress ... which is good .... NEVER TURN THE TAP OFF WITH UR HANDS AFTER U HAVE WASHED THEM ... when u finish washing hold them right together ,and then take 2 napkins : 1- use it to turn off thet tap
2- to warm the sthetoscope before u put in on the chest of patient.
best of luck
___________________
The Maestro says its Mozart...but it sounds like bubble gum
|
| Aps_US
Forum Senior
Topics: 29
Posts: 67
|
thanks a lot icarus..i appreciate ur prompt reply.
|
| icarus
Forum Senior
Topics: 27
Posts: 173
|
u r welcome my friend ,and if anyone feels that something needs to be added , please share ur information with us .... America is a continet guys , so we would all fit in the system if we passed 
___________________
The Maestro says its Mozart...but it sounds like bubble gum
|
| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
|
Aps_US wrote:
hi guys..i had many doubts..do u need to examine all pulses bilaterally in CVS exam?do we need to do a CVS and R/S exam in all abdo cases?is time sufficient to perform neuro exam ?
is there a better word for palpate?do u tell the patient the diagnosis or just some vague ..like infection of liver or bowels or gall bladder or lungs.do u need to perform romberg's sign in all neuro patients?when all do u need a fundus exam?
what do u do when wash hands?ask what question?
thanks a lot..
Not necessarily,
for instance, in a young Pt with traumatic injury of the knee, what's the need to listen to lungs? Do not waist your time, do focused exam of the knee, and then get out...
___________________
Don't live in a town where there are no doctors
|
| icarus
Forum Senior
Topics: 27
Posts: 173
|
Hey justics ,hope everything is good with u , actually even if the person had an injured knee ,u would still listen to heart and chest as part of ROUTINE exam , at least this is what they did in FA ...
best of luck
___________________
The Maestro says its Mozart...but it sounds like bubble gum
|
| Aps_US
Forum Senior
Topics: 29
Posts: 67
|
how do u check for visual acuity.with the chart or fingers.and if we use fingers at what distance do u stand from the patient.
|
| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
|
icarus wrote:
Hey justics ,hope everything is good with u , actually even if the person had an injured knee ,u would still listen to heart and chest as part of ROUTINE exam , at least this is what they did in FA ...
best of luck
Well, if you do everything by FA book, you will run out of time, just take my word... Take case 12 in FA in a confused and forgetful person, and they list EVERYTHING to do, including the neuro... Neuro by itself will take 3-4 min... And then you intend to do pulmo, CVS, etc... BAD idea, BAD idea... Please be focused...
Part of the problem, guys, is that you think everything depends on you... Listening to lungs isn't placing stethoscope on the chest for one second for a single breath cycle... It should be done appropriately... Imagine a confused guy who is slow and not cooperative, and if you plan to do everything as you practice in time-wise manner with your friend, you will fail to do that... remember, that each case is an improvisation, but you have to follow rules, like LIQORAAA, PAMHUGSFOSS SODA, etc... Yes, cover everything with your questions, but then you are to be focused...
GL to everyone...
___________________
Don't live in a town where there are no doctors
|
| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
|
Aps_US wrote:
how do u check for visual acuity.with the chart or fingers.and if we use fingers at what distance do u stand from the patient.
You can order this on WU as testing on a Snellen chart...
___________________
Don't live in a town where there are no doctors
|
| icarus
Forum Senior
Topics: 27
Posts: 173
|
hey justice ,thanks a lot of the insights .... maybe i am being such idealistic lol and probably u are right ... the tension and anxiety would cost us enough time ,not to mention making the PE i talked abt ... so i will do is to make the main system that is related first ( abdominal exam for abd. pain ... neuro for dementia,seizures etc ... chest and heart for SOB ,palpitations and so on ).
Best of luck to everyone
___________________
The Maestro says its Mozart...but it sounds like bubble gum
|
| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
|
icarus wrote:
the tension and anxiety would cost us enough time ,not to mention making the PE i talked abt ... so i will do is to make the main system that is related first ( abdominal exam for abd. pain ... neuro for dementia,seizures etc ... chest and heart for SOB ,palpitations and so on ).
Perfect strategy to follow!!!
___________________
Don't live in a town where there are no doctors
|
| Aps_US
Forum Senior
Topics: 29
Posts: 67
|
thanks a lot justice and icarus..best of luck to you and everyone
|
| icarus
Forum Senior
Topics: 27
Posts: 173
|
Since we are active in the thread ,let me ask u some questions guys :"
If SP has abdominal paint lets say in the RUQ ...
1 -does he feel pain when we auscultate it (due to stetho touch) , or just with palpation ...
2- and if he told us during the history taking that he feels pain there ( and pointed towards RUQ) do we palpate it though he said it hurts him ? or we palpate and then apologize and promise not to do it again ?
and do we put our hand to check murphy on that area though we palpated it and it hurted him ?!?!?
i know i sound silly ... but i am an OC guy !!!! lol
Best of luck friends
___________________
The Maestro says its Mozart...but it sounds like bubble gum
|
|
| |
| | | | | | | | | | | | |
